Treatment

LVEF and Cardiac Dysfunction

Reduced LVEF and cardiac dysfunction

You may have heard your physician use any number of terms – heart failure, cardiomyopathy, LV dysfunction, reduced LVEF. It can certainly be tough to understand what it all means.

The left ventricle (LV) is the main pumping chamber of the heart and responsible for pumping freshly oxygenated blood to the rest of your body. The LV normally ejects about 55-70 percent of the blood it fills with every time it beats. This number is referred to as the ejection fraction.

If the left ventricle becomes weak then the ejection fraction becomes reduced. The left ventricular ejection fraction (LVEF) is a measurement taken during an echocardiogram or other tests, like a cardiac MRI, to measure how much volume of blood is pumped out of the left ventricle and into the aorta and body with each heartbeat.

Without any symptoms, a patient has asymptomatic LV dysfunction. If you have symptoms related to the LV dysfunction, then your doctor may say that you have heart failure. These symptoms can range from swelling in your legs or your belly, or shortness of breath when you lie flat at night. The term cardiomyopathy is a generic term that means the heart muscle is not working normally.

Why does reduced LVEF happen?

There are many different causes for a decrease in LVEF. However, it is known that certain anti- cancer medications, especially anthracyclines (like doxorubicin), can make the heart muscle weak over time and the pumping action, or the LVEF, becomes less strong at pumping blood through the arteries.

How can cardiac dysfunction be managed?

A cardio-oncologist will review a series of your tests, like echocardiograms or electrocardiograms (ECG), which will display the condition of your heart. Other standard blood tests, such as BNP (B-type natriuretic peptide) or troponin, are used to determine the status of your cardiac function and whether there is any cardiac injury.

It may be necessary to initiate one or two common cardiac medications to improve cardiac function and prevent the LVEF from worsening. Overall, the function of your heart can be improved by taking proper cardio-protective medications as well as improving your diet and the amount of exercise you may participate in. If your heart is followed closely and your treatment is optimized, many problems are caught early or even prevented.

Is reduced LVEF permanent?

Often, with early identification of a reduced LVEF or cardiac dysfunction, and by adding cardio-protective medications, the heart muscle is able to recover and the LVEF percentage may improve. In some situations, your cardiologist and oncologist will discuss your test results and may agree to hold your anti-cancer therapy for a short time to allow your heart muscle to rest and recover. Ultimately, the goal is to maintain a healthy heart to pursue a full course of anti-cancer therapy.